Drugs & MedicationsHealthcare PolicyPhysician Office Issues


I’ve seen dozens of ads on television for prescription drugs patients can obtain without actually seeing a doctor. As a physician that bothers me. I was taught in medical school to obtain a prescription, a patient had to visit the doctor, undergo a physical examination, and have a diagnosis made. Only then was a prescription legally justified. The authority to write a prescription is a sacred, ethical responsibility earned only by those trained to consult, examine, and diagnose. Depending on the drug in question, however, the rules for writing and dispensing prescriptions, once very strict and limited, have become quite lax. Drugs can now be obtained by a brief phone or internet “consultation.” 

The ad I’ve seen most frequently is for Roman, the website that treats erectile dysfunction, male pattern baldness, premature ejaculation, and low testosterone. In fact, Roman has run ads during almost every televised athletic event I’ve watched over the past three years. Their ads are incredibly provocative and leave little to the imagination. 

Their obvious purpose is to sell as much sildenafil (Viagra), testosterone, finasteride (Proscar), and minoxidil (Rogaine) as possible to men who desire to be young and virile again. These drugs are in high demand, and since many men are reluctant to go to the doctor and admit they have a problem, Roman has found a way to by-pass that barrier. Using an online questionnaire, Roman investigates the patients’ need and assesses the appropriateness of available treatments. If the patient passes the questionnaire, they have a brief online or phone consultation with a “professional.” A supply of the indicated drug is then shipped to the patient. Roman has employed this system to prescribe drugs without actually examining the patient, exploiting the situation to the max. I’m sure their business revenues are incredible.

Online prescribing has reached a higher level of concern. When I read in JAMA about 2 websites that sell amphetamine drug products online without a prescription, it concerns me. Amphetamine stimulant drugs, also called speed, meth, or uppers, are the scourge of Appalachia and the Plains. They are obtained illegally and abused all over the U.S. The FDA has laws prohibiting this, and through a “warning letter, advised kubapharm.com and premiumlightssupplier.com of their ill-legalities in regard to the Federal Food, Drug, and Cosmetic Act. Adderall, a drug for ADHD, and other such stimulant drugs, were being purchased by consumers of these websites without a prescription. The “DEA strongly urges anyone seeking controlled medications to obtain a prescription from a trusted medical professional and have it dispensed by a licensed pharmacy.”

I couldn’t agree more. We already have a methamphetamine crisis in this country, and these websites are enabling it—making it worse. What they are doing is against the law and everyone knows it. The FDA has the authority to shut these websites down and should do so instead of sending a powerless, ineffective warning letter. What a joke! 

Dr. G’s Opinion: I’m concerned about those websites that sell drugs without a prescription. To me it’s an illegal and unethical practice. Roman is dealing with sex-related products, some of which have serious side effects (ie. priapism-the erection lasting four hours!), so there is concern but far less so than websites that are selling controlled substances without a prescription. That’s just plain wrong, and is flaunting our controlled substance laws. Instead of an FDA letter, the DEA (Drug Enforcement Administration) needs to shut these sites down and indict the developers for drug trafficking. 

Reference: News from the FDA. Rubin, Rita. Websites selling controlled drugs without a prescription. JAMA 2022 May 17;327(19):1860.

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